Cardiovascular History Taking

Cardiovascular history taking is an important skill that is often assessed in the OSCE setting.
Its important to have a systematic approach to ensure you dont miss any key information. The
guide below provides a framework to take a thorough cardiovascular history.

Presenting Complaint
Its important to use open questioning to elicit the patients presenting complaint
So whats brought you in today? or Tell me about your symptoms
Allow the patient time to answer, trying not to interrupt or direct the conversation.
Facilitate the patient to expand on their presenting complaint if required
Ok, so tell me more about that Can you explain what that pain was like?

History of Presenting Complaint

Onset - When did the symptom start?
Acute or gradual Did it come on suddenly or has it gotten worse gradually?
Duration? minutes / hours / days / weeks / months / years
Progression of symptom - Has it gotten worse/better or stayed same over the stated time frame?
Intermittent or continuous? Is the symptom always there or does it come and go?

Pain if pain is a symptom, clarify the details of the pain using SOCRATES

Site - where exactly is the pain / where is the pain worst

Onset - when did it start? / did it come on suddenly or gradually?
Character - what does it feel like? (sharp stabbing / dull ache / burning?)
Radiation - does the pain move anywhere else? (e.g. chest pain with left arm radiation)
Associations - any other symptoms associated with the pain (e.g. chest pain with SOB)
Time course does the pain have a pattern (e.g. worse in the mornings)
Exacerbating / Relieving factors - anything make it particularly worse or better?
Severity - on a scale of 0-10, with 0 being no pain & 10 being the worst pain youve ever
felt

Associated symptoms dyspnoea, chest pain, orthopnea, PND, palpitations, syncope, sweating,
nausea, leg swelling, reduced exercise tolerance, fever, loss of consciousness, cough
Cardiovascular Risk Factors:

Hypertension - if patient unsure, check their medications

Smoking - very important risk factor, establish how many a day for how long
Hypercholesterolaemia - patients often dont know ask if their on a statin or check
Diabetes - establish how long theyve had it & how good their glycaemic control is
(HBA1C useful)

Ideas, Concerns & Expectations

Ideas what are the patients thoughts regarding their symptoms?

Concerns - explore any worries the patient may have regarding their symptoms
Expectations - gain an understanding of what the patient is hoping to achieve from the
consultation

Summarising

Summarise what the patient has told you about their presenting complaint.
This allows you to check your understanding regarding everything the patient has told you.
It also allows the patient to correct any inaccurate information & expand further on certain
aspects.
Once you have summarised, ask the patient if theres anything else that youve overlooked.
Continue to periodically summarise as you move through the rest of the history.

Signposting

Signposting involves explaining to the patient;

What you have covered Ok, so weve talked about your symptoms & your concerns
regarding them
What you plan to cover next - Now Id like to discuss your past medical history and
your medications

Past Medical History

Medical conditions - AF, hypertension, hypercholesterolaemia, ischaemic heart disease, etc
Any operations? - CABG, Stents, valve replacements, Fem-Pop bypass, Amputation, etc
Any acute hospital admissions? when and why?

Drug History
Regular medication? Beta blockers, Antihypertensives, Calcium channel blockers, etc
Over the Counter drugs? - NSAIDS etc
Herbal remedies? - St Johns Wart enzyme inducer can affect Warfarin etc
Contraceptive pill? - increased risk of thromboembolic disease
Home oxygen? - patient may have end stage COPD with Cor-pulmonale
ALLERGIES?

Family History
Any illnesses that seem to run in the family? - MIs, Hypertension, Thrombophilia, etc
Are parents still in good health? if deceased determine age & cause of death
Any unexplained deaths in young relatives? - Long QT syndrome / Channelopathies

Social History
Smoking - How many cigarettes do they smoke a day? How many years have they smoked for?
Alcohol - How many units a week? Be specific about type / volume / strength of alcohol.
Drug use - Cocaine causes coronary artery vasospasm can present as young person with chest
pain
Diet - Overweight? Fatty foods? Salt intake? significant cardiovascular risk factors
Exercise levels - gives an idea regarding baseline level of patients activity

Living Situation:
House/bungalow? the presence of stairs is important will the patient manage?
Who lives with the patient? are they a source of support?
Any carer input? - what level of care do they receive?

Activities of Daily Living - Does illness impact patients ADLs? e.g. stairs, going to shop,
cooking
Occupation? - those with sedentary jobs are at increased cardiac risk e.g. Lorry Driver

Systemic Enquiry
Systemic enquiry involves performing a brief screen for symptoms in other body systems.
This may pick up on symptoms the patient failed to mention in the presenting complaint.
Some of these symptoms may be relevant to the diagnosis e.g. reduced urine output in fluid
overload
Choosing which symptoms to ask about depends on the presenting complaint & your level of
experience

Cardiovascular Chest pain / Palpitations / Cyanosis / SOB / Syncope / Orthopnoea / Ankle

swelling
Respiratory Cough / Sputum / Chest Pain / SOB / Wheezing / Stridor/ Haemoptysis
GI - Appetite / Nausea / Vomiting / Indigestion / Dysphagia / Weight loss /Pain / Bowel habit
Urinary - Frequency / Dysuria / Polyurea / Urgency / Hesitancy / Nocturia / Incontinence
Nervous System Vision / Headache / Weakness / Sensory disturbance / LOC / Seizures /
Incontinence
Musculoskeletal Bone & Joint pain / Muscle pain / Joint swelling / Difficulty mobilising
Dermatology Rashes / Skin breaks / Ulcers